Receipt and Transfer Form

Chemical Receipt & Transfer Form

In the event that you have received a chemical that did not pass through the chemical transfer station, please enter the requested information to update your chemical inventory. If you have multiple containers of the same chemical, use the comments box to add the additional barcodes. By submitting this form you automatically send an email to the Office of Environmental Health and Safety. If you have questions, please call 862-1510.

Date chemical(s) received or transferred:
Chemical Owner:
New Chemical Owner: (if transferred)
Department :
E-mail address (required)

Barcode #:
Vendor Name:
Chemical Description:
Catalog Number:
Size:
Container type:
Chemical state:
CAS (if known):
Building:
Room #:
Receipt:
Relocate:
Refill:
Transfer:

Please enter comments as appropriate.